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General NPI Number Information
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NPI Number | 1639885627
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Entity Type | Organization
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Legal Business Name | OCEANVIEW ORTHOTIC SUPPLIES LLC
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 6011 RODMAN ST STE 111
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City | HOLLYWOOD
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State | FL
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Zip | 33023-1854
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Country | US
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Telephone | 954-516-0877
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Fax | 954-516-0887
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Provider Business Mailing Address
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Address Line | 6011 RODMAN ST STE 111
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City | HOLLYWOOD
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State | FL
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Zip | 33023-1854
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Country | US
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Telephone | 954-516-0877
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Fax | 954-516-0887
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Authorized Official
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Title or Position | CEO / PRESIDENT
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Name | JOHN DAIRO GOMEZ MEJIA
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Credential |
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Telephone | 954-516-0877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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